1063851210 NPI number — VANESSA COLLEEN FARRER PT, DPT

Table of content: (NPI 1578012308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063851210 NPI number — VANESSA COLLEEN FARRER PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRER
Provider First Name:
VANESSA
Provider Middle Name:
COLLEEN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063851210
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1765 JUAREZ ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEASIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93955-4005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-601-4811
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 CASS ST
Provider Second Line Business Practice Location Address:
116
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-372-0651
Provider Business Practice Location Address Fax Number:
831-372-0655
Provider Enumeration Date:
06/20/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  38627 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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